Exam 1 Review for Finals Flashcards
CO2 level
20 - 31 mEq/L
Specific gravity level
1.005 - 1.030
- Less than 1.005 = dilute urine, hypervolemia
- Greater than 1.030 = concentrated urine, hypovolemia
BUN level
6 - 20 mg/dL
Glucose level (fasting)
70 - 110 mg/dL
Platelet level
150,000 - 450,000 /uL
WBC level
4500 - 10,500 / uL
Hemoglobin level
M: 13.5 - 17.5 g/dL
F: 12 - 16 g/dL
Potass levels
3.5 - 5.0 mEq/L
Chloride levels
97 - 107 mEq/L
Sodium levels
135 - 145 mEq/L
Hematocrit level
Male: 42-52%
Female: 37-47%
Hypervolemia lab values
- *Decreased H&H, BUN (dilutional)
- *Decreased sodium
- *Decreased urine specific gravity
Hypovolemia lab values
- *Altered H&H
- *Increased BUN
- *Increased serum sodium
- *Decreased serum potassium
- *Increased urine specific gravity
Hypovolemia treatment
- Fluid replacement (oral, enteral, parenteral)
- Parenteral fluids: 5% dextrose with 0.45% NS or 0.45% NS
Hypovolemia causes
- Fluid shifts (third spacing)
- Excessive loss of fluid
- Lack of fluid intake
- Diabetic ketoacidosis
Hypovolemia clinical manifestations
- Weight loss
- Decreased skin turgor
- Dry mucous membranes
- Concentrated urine output
- Oliguria (decreased urine output)
- Thirst
- Anxiety/restlessness
- Decreased BP / tachycardia (bc heart is trying to compensate)
Hypervolemia causes
- Heart failure (fluid backs up)
- Increased water and sodium retention
- Increased sodium intake
- Cirrhosis
Hypervolemia clinical manifestations
- Weight gain
- Ascites / edema
- Polyuria
- Pulmonary edema (function of heart failure –> backflow into pulmonary veins)
- Jugular vein distension
- Extra heart sounds (S3) and adventitious lung sounds
- SOB, increased RR, increased BP
Hypervolemia treatment
- Restrict fluid intake
- Discontinue IV fluids
- Diuretics
- Dialysis
Hyponatremia causes
- Heart failure
- Meds (diuretics)
- Vomit/diarrhea
- Hyperglycemia w glucosuria
- Perspiration
Hyponatremia clinical manifestations
- *Neurological
- Cerebral edema
- Lethargy/weakness
- Headache
- Confusion
- Muscle cramps and altered gait
- Serious complications: seizures, coma, death
Hyponatremia medical management
- Sodium replacement (oral, enteral, parenteral)
- Fluid restriction 1500-2300
- Parenteral replacement w isotonic IV fluids: 0.9% normal saline
- Diuretics
- Setting of neurological involvement: hypertonic IV fluids (3-5% saline solutions)
Hypokalemia causes
- Losses in GI Tract (vomit, diarrhea, gastric suction, excessive laxative)
- Medications: loop diuretics, thiazide diuretics, aminoglycosides (antibiotic type), steroids, albuterol
- Lack of potassium rich foods
Hyperkalemia causes
- Acute or chronic renal failure (bc major excretor of K)
- Excessive intake of foods high in potassium: banana, potato, leafy greans
- Medications: potass-sparing diuretics, NSAIDs, potass supplements, beta blockers, digitalis
- Shift of intracellular potass to extracellular space: crush injuries, metabolic acidosis
Hyperkalemia medical management
- Dietary modifications
- IV dextrose and insulin administration (glucose shift which K follows)
- Loop diuretics
- Kay-exalate (promote GI excretion of K)
- Severe: calcium to reverse arrythmias, not lower K
Hypokalemia medical management
- Potass supplement (oral preferred)
- Cardiac monitoring
- Intravenous access
*Monitor digoxin levels and administer potass slowly d/t arrhythmias + irritation
Stable angina
- Fixed plaque
- Predictable
- Exacerbated w exercise, alleviated w rest/meds
Unstable angina
- Occlusive thrombus (blockage)
- Medical emergency
- 1st phase of acute coronary syndrome
- Precursor to MI
Prinzmetal angina
- Not due to obstruction; abnormal spasms of arteries + atherosclerosis usually present
- Spasms occlude vessels
- Occur between 12am - 8 am
Stable angina management
- Nitroglycerin
- Other meds that reduce risk factors like DM, HTN, HD
Unstable angina management
- MOAN/MONA: morphine, oxygen, nitroglycerin, aspirin (blood thinner)
- Other meds: CCB, BB, anticoagulants
Prinzmetal angina management
- Statins (lipitor)
- ACE inhibitors
- BB
Nitroglycerin administration
- No more than 3 doses taken 5 minutes apart
- Call 911 if pain (angina) persists after
- Preferred route: sublingual, IV (fast absorption)
CAD lifestyle management / prevention
- *Cardiac rehab
- Diet
- Exercise
- Smoking cessation
- Alc cessation
- Depression/anxiety assessment
Cardiac catheterization & angiography nursing implications
- Maintain pt on flat bedrest for 2-6 hrs to prevent stress on insertion
- Observe catheter site for bleed or hematoma
- Assess renal function, H&H, coagulation
What is Peripheral Artery Disease (PAD)
- Obstruction of blood flow to LEs (occlusion) –> depriving of O2
Six Ps of ischemia
- Pain
- Pallor
- Pulselessness
- Paresthesia (tingling)
- Paralysis (muscle atrophy)
- Poikilothermia (cold)
PAD complications
- Critical limb ischemia
- Acute limb ischemia
PAD nursing action
- Administer meds: antihypertensives, antiplatelets
- *Proper positioning: pt legs shud be dependent (eg. hang over bed) to facilitate blood flow
PAD pt teaching
- *Positioning
- *Inspect feet daily
- *Report chest discomfort
- LIfestyle change: DASH, no alcohol, no smoking, moderate exercise
TIA/Stroke clinical manifestations (complication of carotid disease)
- Sudden weakness
- Dizziness
- Loss of coordination
- Difficulty talking
- Facial droop
- Sudden vision problems
- Sudden and severe headache
*BE FAST = balance, eyes, face, arm, speech, time
HTN clinical manifestations
(chronically uncontrolled, primary)
- Headache
- Chest pain
- Vision changes
- SOB
- Renal dysfunction
- Dizziness
- Fatigue
- Nosebleeds
Hypertensive crisis
- Hypertensive urgency
- Hypertensive emergency
- Target organ damage (heart, brain, kidney, eyes)
HTN pt teaching
- *Monitor BP at home
- *Know SS and complications
- Med adherence
- Lifestyle change adherence
HTN nursing action
- Meds (diuretics, CCB, BB, ACEi)
- DASH diet: 1600mg of Na / day
Normal HR
60-100 bpm
Virchow’s triad
Factors that contribute to venous thrombosis
- Decreased flow rate of blood OR stasis of blood flow
- Endothelial injury (damage to BV wall)
- Hypercoagulability (increased tendency of blood to clot)
DVT clinical manifestations
Asymptomatic or symptomatic (depends on clot itself)
- *Pain
- Swelling
- Tenderness
- Color changes
- *Redness
- *Warmth
DVT nursing action
Prevention:
- Low DVT risk: ambulation
- High DVT risk, low bleed risk: Lovenox or Heparin
- High DVT/bleed risk: compression stockings, SCDs
*Avoid SCD in leg WITH DVT
Pneumonia risk factors
- Advanced age
- Long-term care residents
- Smoking
- Chronic resp disease
- Immunocompromised
- Prolonged immobility
- Aspiration of stomach content (AMS can cause this)
- Prolonged NPO status
- Diminished consciousness, gag reflex, swallow reflex
- *Hospitalization longer than 48 hrs
- Recent abx therapy
Pneumonia clinical manifestations
- *Fever
- Tachypnea
- *Chills
- Cough, non-prod/prod
- *Pleuritic chest pain
- *Fatigue
- *Myalgias, arthralgias
Severe: purulent/blood tinged sputum, hypotension, dysrhythmia
Types of pneumonia
- Community-acquired
- MRSA community-acquired
- Hospital-acquired (occurs 48 hrs after admission)
Pneumonia nursing action
- Administer *humidifed O2 as ordered
- Administer meds: antibiotics
- *Pulmonary hygiene: incentive spirometer, ambulation, make sure pt coughing up secretions
- Pt positioning
- *Monitor intake & output
- *Ensure adequate nutritional support (most pts tired so don’t wanna eat + difficulty breathing)
- Activity
OSA risk factors
- Male
- *Obesity
- Smoking
- Alc use
- *Age 40-45
- Craniofacial or upper airway abnormalities
OSA risks what?
Increased risk of CV disease bc excessive inflamm process d/t decreased blood flow. Also cause scarring.
OSA treatment (supportive)
- CPAP (pressure keeps airway open)
- Nonsupine sleeping
- No alc or sedative before bed
- Oral appliance to forward tongue to keep airway open
OSA pt teaching
- Disease process
- Instruct pt on CPAP + meds
- Instruct pt on weight reduction
Asthma clinical concern
- Wheezing: concern when on inspiration & expiration
Types of COPD
- Emphysema
- Chronic bronchitis
Emphysema
- Alveolar destruction
- CO2 can’t leave and O2 can’t enter: ineffective gas exchange
- Loss of lung elasticity causes air trapping and distension in alveolar
Chronic bronchitis
- Inflamm of bronchi and bronchioles
- Small vessels are affected first
- Increased mucus production, causing vessel wall thickening and airflow obstruction
COPD nursing assess
- Vital signs
- *Lung sounds: crackles or wheezes
- Pursed lip breathing: keeps airways open for gas exchange
- *Cough
- Dyspnea (subjective finding)
- Weight loss d/t pt fatigue from breathing & not eating
COPD pt teaching
- Breathing technique: pursed lip
- Pacing of activities of daily living to prevent fatigue
- Smoking cessation
- Med regiment: inhaler use, regimen, schedule
- Vaccine prophylaxis: RSV, influenza, covid
- Nutrition (often too tired to eat)
- Coping mechanisms: depression
Sickle cell disease patho
- Genetic disorder of Hgb –> RBC shape changed d/t lack of O2
- Sickle shaped RBC causes vasoocclusion, lack of O2, hemolysis (breaks up which causes anemia)
Sickle cell disease clinical manifestations (no crisis)
Anemia
- Fatigue
- Pallor
- SOB
Sickle cell disease clinical manifestations (crisis)
Vasoocclusive
- Pain
- Swelling
Sickle cell anemia assess
- VS: tachycardia, tachypnea, fever (infection)
- Fatigue, pallor, SOB
- Pain and swelling in joints, jaundice (if hemolytic crisis)
- Psychosocial: depression, anger
- Diagnostic tests
Sickle cell anemia nursing action
- Administer O2 as ordered
- Provide hydration/fluids esp for kidney bc need to prevent infection
- Pain meds as ordered
- Antipyretics as ordered
- Blood transfusions as ordered
- Emotional support
Sickle cell anemia patient teaching
- Avoid cold temps and restrictive clothing
- Patho of disease
- Infection prevention (vaccines, dental hygiene, hand washing…)
- Avoid high-altitudes
Iron deficiency anemia clinical manifestation
- Fatigue, pallor
- *Tachycardia bc lack of blood
- *Tachypnea
- *SOB
- Fissures (mouth/anus)
- Glossitis (tongue: smooth, swollen, reddened)
- Spoon-shaped fingernails (not common in industrialized countries)
- Brittle hair
First line treatment of iron deficiency anemia
Oral iron
What happens to number of cells in infection?
increase in neutrophils, segmented neutrophils, neutrophil bands
- Shift to left: abundant neutrophils consumed, creating immature neutrophils
what is Role of Vitamin C with iron supplements?
increase iron absorption
Iron rich foods
meat
dark leafy vegetables
dried beans
beets
fortified cereal/bread
cream of wheat
Side effects of oral iron
-nausea, abdominal discomfort, constipation, diarrhea, dark/tarry stools (not blood)
-constipation prevention
Assessing pallor in dark-skinned patients
compare palms, pull down eyelid (will be pale)
Status asthmaticus S&S
- Chest tightness, wheezing, dry cough, shortness of breath, severe respiratory distress
- Unresponsive to typical rescue treatment with bronchodilators
- Bronchospasm, inflammation, increased mucus or mucus plugging
Asthma triggers
cigarette smoke, mold, pollen, dust, animal dander, air pollutants, viral infections, nasal polyps, allergic rhinitis, food and drug allergies, and emotional stress
Influenza vacc important aspects
-Contraindicated in those with egg allergies (egg protein in vaccine)
-80% protective
based on the genetic makeup of influenza viruses which caused outbreaks in previous year
-best time → early fall
-mild side effects: low- grade fever/injection site soreness
Lab values to assess for pt on heparin drip
aPTT - evaluates the intrinsic coagulation cascade and is used to evaluate the effectiveness of heparin.
Lab values to assess for pt on coumadin
-INR measures therapeutic levels
-takes 3-4 days to achieve therapeutic anticoagulation
-medication usually taken 3-6 months after DVT
Pt education diet for pt on Coumadin
avoid foods with vitamin K - dark green leafy vegetables
-Works in the liver to inhibit synthesis of four vitamin K-dependent clotting factors
S&S of L heart failure
-shortness of breath/dyspnea/orthopnea
-crackles on auscultation
-pale color and weak pulse
-extremities are cool to touch
-delayed capillary refill
-fatigue and weakness
S&S of R heart failure
jugular vein distension
dependent edema
hepatomegaly
ascites
Role of BNP
higher level=HF
beta blockers and heart failure
- Works against the sympathetic nervous system response in HF which causes tachycardia,
- Decreases cardiac workload
Labs assessing cardiac damage
Troponin and CK-MB
Characteristics of normal EKG
pQRSt waves
Isotonic fluids
- 0.9% sodium chloride
- 5% dextrose in water
- Lactated ringers
Hypotonic fluids
- 0.45% sodium chloride
- 0.34% sodium chloride
- 2.5% dextrose in water
Hypertonic fluid
- 3% sodium chloride
- 5% dextrose in LR
- 20% dextrose in water
- Albumin 25%
